Welcome to. Presented by the Transplant Pharmacy B4/6. Ed Portillo - Danielle Leach - Jillian Descourouez 1

Welcome to Presented by the Transplant Pharmacy B4/6 Ed Portillo - Danielle Leach - Jillian Descourouez 1

Taking your Medications Page 1 Tools and Resources Page 2 Transplant Medications and Page 3 Supplements 3

Importance of Adherence Adherence means taking medications exactly as the directions or health care provider says. Non-adherence leads to increased risk of organ loss. 5

Why do some people struggle with adherence? Confusion Unable to pay Lack of supply Side-Effects Key: Do NOT stop taking your medications unless told to do so by your coordinator or doctor. 6

Summary Medication adherence is key Follow your discharge paperwork 7

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Important phone numbers: UW Mail Order Pharmacy (866) 894-3784 UW Outpatient Pharmacy (608) 263-1280 Transplant Pharmacy B4/6 (608) 263-7229 Transplant Unit B4/6 (608) 263-8737 Transplant Clinic (608) 262-5420 11

Medication List: Every patient should have an up-todate medication list. Bring this list to all appointments. 12

Medication Box: Helps you to organize medications. 13

UW Mail Service Pharmacy Medications are mailed to your home Speak with pharmacy technician 14

Local Pharmacy Some pharmacies fill medication boxes for you or offer automatic refill reminders. 15

Medication Resources Transplant B4/6 Pharmacists Available by phone from: 7:00AM-10:00PM (M-F) 8:00AM-4:00PM (Sat-Sun) You may also call the B4/6 unit, and the coordinator will page the pharmacist. 16

Physician Approval of Additional Refills If you are on your last refill of a medication or run out, call your pharmacy. Refills cannot be given through your primary doctor. 17

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Refills at UW Hospital s Outpatient Pharmacy Call three days ahead to refill your prescription If you wish to refill your prescriptions at your local pharmacy, have them call the University of Wisconsin Hospital s Outpatient Pharmacy to transfer the prescription. 19

Summary Have a list of important phone numbers Keep an up to date medication list Call for medication refills one week prior to your planned pick-up date 20

Question 1: Tim Thompson has noticed he is out of refills for tacrolimus, one of his important transplant medications. Who should he contact to obtain refills? His A. Transplant Coordinator B. Local Pharmacy at least 3 days in advance C. Favorite dentist 21

Question 1: Tim Thompson has noticed he is out of refills for tacrolimus, one of his important transplant medications. Who should he contact to obtain refills? His A. Transplant Coordinator B. Local Pharmacy at least 3 days in advance C. Favorite dentist 22

Medication Table of Contents: Anti-Rejection Medications Anti-Infective Medications Supplements & Other 25

Medications Group #1 New Organ Healthy Group #2 You Healthy -Anti-Rejection Medications -Anti-infective medications -Supplements/other 26

The Typical Home Treatment: Anti-Rejection Medications The Big 3 1.) Tacrolimus 2.) Mycophenolate 3.) Prednisone Anti-Infective Medications Antibiotic Anti-fungal Anti-viral Supplements & Other 27

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Who should know about my medications? Tell ALL of your healthcare providers that you are on anti-rejection medications. Dentist Doctors or Surgeons Pharmacists 29

Who should know about my medications? Tell your transplant coordinator if other doctors make medication changes before taking them. 30

Medication Table of Contents: Anti-Rejection Medications Prednisone Tacrolimus Mycophenolate Sodium Anti-Infective Medications Supplements & Other 33

Side Effects Food Special Tips Increased blood pressure, cholesterol and blood sugar, thinning skin, easier bruising, holding fluid (edema), hyperactivity, mood changes, decreased bone mass, stomach upset, stomach ulcers, trouble sleeping, bigger appetite, and risk of cataracts. Take with food to prevent upset stomach. If you have high blood sugar or diabetes, your dose may be split to twice daily. If you have a single dose, you should take it in the morning so it is easier to sleep. Have an eye exam once a year for cataract prevention. 35

Side Effects Food Interactions Monitoring Tremor, headache, kidney injury, hair loss, diarrhea, nausea/vomiting, trouble sleeping, and increased cholesterol, blood sugar and blood pressure. Take with or without food, but be CONSISTENT in what you choose. Take tacrolimus one hour before or two hours after antacids, certain supplements, and dairy products. Avoid grapefruit or pomegranate juice. DO NOT take your morning dose of tacrolimus until AFTER your blood is drawn. 38

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Side Effects Food Interactions Special tips Diarrhea, nausea/vomiting, headache, and decreased cell counts (white blood cells and hemoglobin). Take with food to prevent stomach upset. Take mycophenolate one hour before or two hours after antacids, certain supplements, and dairy products. Do not crush, chew, or cut mycophenolate tablets. Pregnant women should not handle the tablets or capsules. All female patients able to bear children must use an appropriate form of birth control. 42

Cyclosporine (Neoral TM ) - Alternative to tacrolimus Azathioprine (Imuran TM )- Alternative to mycophenolate Sirolimus (Rapamune TM )- Alternative to mycophenolate or tacrolimus Everolimus (Zortress TM )- Alternative to mycophenolate or tacrolimus Belatacept (Nulojix TM )- Alternative to Tacrolimus 43

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Summary You are taking three medications to prevent organ rejection Take prednisone with food Avoid antacids and certain supplements with tacrolimus and mycophenolate Do not crush or cut mycophenolate tablets 45

Question 2: Jenny Jacobson just received a transplant, and is now trying to remember what products should always be spaced at least one hour before or two hours after her mycophenolate. What product should we tell her to space out from her mycophenolate? A.Antacids, such as aluminum, magnesium, calcium B.Tacrolimus C.Prednisone D.Candy bars 46

Question 2: Jenny Jacobson just received a transplant, and is now trying to remember what products should always be spaced at least one hour before or two hours after her mycophenolate. What product should we tell her to space out from her mycophenolate? A.Antacids, such as aluminum, magnesium, calcium B.Tacrolimus C.Prednisone D.Candy bars 47

Question 3: Jenny Jacobson just received a transplant and has a lab draw scheduled today for one of her anti-rejection medications. Jenny is now trying to remember what medication should not be taken until after her lab is drawn. What should we tell her this medication is? A. Prednisone B. Mycophenolate C. Multivitamin D.Tacrolimus 48

Question 3: Jenny Jacobson just received a transplant and has a lab draw scheduled today for one of her anti-rejection medications. Jenny is now trying to remember what medication should not be taken until after her lab is drawn. What should we tell her this medication is? A. Prednisone B. Mycophenolate C. Multivitamin D.Tacrolimus 49

Getting Your Shots (Immunizations) DO NOT receive any immunizations without your transplant coordinator s approval. The major vaccines to receive are: Influenza Pneumonia Tetinus AVOID live vaccines, including: Shingles, chicken pox, and the influenza nasal spray. 52

Why do I need anti-infective medications? Because your immune system is suppressed, you are at a greater risk for becoming sick. Anti-infective medications help prevent infections for a period of time after transplant. If you experience any signs of infection, call your coordinator. 53

Preventing General Infections and Pneumonia Prevent bacterial infection Trimethoprim/Sulfamethoxazole (Bactrim DS or Septra DS) Prevent viral infection Valganciclovir (Valcyte) Acyclovir (Zovirax) Prevent fungal infection Clotrimazole Troche (Mycelex) or suck tab Nystatin (Swish and swallow) 54

Preventing General Infections and Pneumonia Prevent bacterial infection Trimethoprim/Sulfamethoxazole (Bactrim DS or Septra DS) Trimethoprim/Sulfamethoxazole (Bactrim DS or Septra DS) Prevent viral infection Valganciclovir (Valcyte) Acyclovir (Zovirax) Common Directions Duration Take 1 tablet by mouth once daily Dose may be reduced based on kidney function Taken for one year after transplant Prevent fungal infection Clotrimazole Troche (Mycelex) or suck tab Nystatin (Swish and swallow) Side Effects Sun sensitivity, nausea/vomiting, diarrhea, rash, high potassium, low white blood cells. 55

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Preventing General Infections Preventing General Infections and Pneumonia Prevent viral infection Valganciclovir (Valcyte) Acyclovir (Zovirax) Valgancyclovir (Valcyte) Prevent fungal infection Common Directions Take 1 tablet by mouth once daily Clotrimazole Troche (Mycelex) or suck tab Nystatin (Swish and swallow) Duration Side Effects Common Directions Duration Side Effects Dose may be reduced based on kidney function Taken for six months after transplant Decreased white blood cell count Acyclovir (Zovirax) Take by mouth 1 to 4 times daily based on kidney function Taken for three months after transplant Decreased white blood cell count 59

Preventing General Infections Preventing General Infections and Pneumonia Prevent viral infection Valganciclovir (Valcyte) Acyclovir (Zovirax) Valgancyclovir (Valcyte) Prevent fungal infection Common Directions Take 1 tablet by mouth once daily Clotrimazole Troche (Mycelex) or suck tab Nystatin (Swish and swallow) Duration Side Effects Common Directions Duration Side Effects Dose may be reduced based on kidney function Taken for six months after transplant Decreased white blood cell count Acyclovir (Zovirax) Take by mouth 1 to 4 times daily based on kidney function Taken for three months after transplant Decreased white blood cell count 60

Preventing General Infections Preventing General Infections and Pneumonia Prevent fungal infection Clotrimazole Troche (Mycelex) or suck tab Nystatin (Swish and swallow) Clotrimazole Troche (Mycelex) or Suck Tab Prevent fungal Dissolve infection the tablet by mouth 2 times daily. Clotrimazole Do not eat Troche or drink (Mycelex) for 10-15 minutes or after suck each tab dose. Nystatin (Swish and swallow) Common Directions Duration Side Effects Common Directions Duration Side Effects Taken for three months after transplant Nausea, odd taste in the mouth. Nystatin (Swish and Swallow) Shake the bottle well. Swish 5 ml (one teaspoonful) in your mouth and swallow 2 times per day. Do not eat or drink for 10-15 minutes after taking your dose. Taken for three months after transplant Nausea, odd taste in mouth 63

Preventing General Infections Preventing General Infections and Pneumonia Prevent fungal infection Clotrimazole Troche (Mycelex) or suck tab Nystatin (Swish and swallow) Clotrimazole Troche (Mycelex) or Suck Tab Prevent fungal Dissolve infection the tablet by mouth 2 times daily. Clotrimazole Do not eat Troche or drink (Mycelex) for 10-15 minutes or after suck each tab dose. Nystatin (Swish and swallow) Common Directions Duration Side Effects Common Directions Duration Side Effects Taken for three months after transplant Nausea, odd taste in the mouth. Nystatin (Swish and Swallow) Shake the bottle well. Swish 5 ml (one teaspoonful) in your mouth and swallow 2 times per day. Do not eat or drink for 10-15 minutes after taking your dose. Taken for three months after transplant Nausea, odd taste in mouth 64

Hand hygiene 65

Summary Avoid live vaccinations You are taking three medications to prevent bacterial, viral, and fungal infections. Take Bactrim TM with food. Do not eat or drink for 10-15 minutes after taking clotrimazole or nystatin. 66

Question 4: Peggy Potter is taking Bactrim (trimethoprim/sulfamethoxazole) as prescribed. What should she always remember to do as a transplant patient, and especially while on Bactrim? A.Wear Sunscreen B.Avoid pink t-shirts C.Avoid drinking water D.Take on an empty stomach 67

Question 4: Peggy Potter is taking Bactrim (trimethoprim/sulfamethoxazole) as prescribed. What should she always remember to do as a transplant patient, and especially while on Bactrim? A.Wear Sunscreen B.Avoid pink t-shirts C.Avoid drinking water D.Take on an empty stomach 68

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Supplements & Other Medications Most of these products are available without a prescription (over the counter) These products with doses will be listed on your discharge medication list. You will need to buy these at a local pharmacy after discharge. 72

Supplements & Other Medications Supplement/Medication Purpose Calcium (carbonate or citrate) Vitamin D (cholecalciferol) Multivitamin Pantoprazole (Protonix) or Omeprazole (Prilosec) or Lansoprazole (Prevacid) Aspirin 81 mg Prevents bone loss from prednisone Helps your body absorb calcium General health Prevents stomach ulcers due to prednisone Prevents blood clots for heart health 73

Other Possible Medication Changes Blood Pressure Medications (Usual goal: less than 130/80 mmhg) Medication for High Blood Sugar (Diabetes) and for high cholesterol. 74

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Medications and Foods to Watch Medications not in this handout Pain medications- key points: 76

Medications and Foods to Watch Medications not in this handout Pain medications- key points: 77

Medications and Foods to Watch Medications not in this handout Pain medications- key points: = = 78

Medications and Foods to Watch Medications not in this handout Pain medications- key points: = = 79

Medications and Foods to Watch Medications not in this handout Pain medications- key points: = 80

Avoid grapefruit, grapefruit juice, pomegranate, and pomegranate juice. 81

Avoid grapefruit, grapefruit juice, pomegranate, and pomegranate juice. 82

Medication missed doses Follow the Half-Way Rule, but notify your coordinator when you miss a dose of antirejection medications. 83

Example #1 Dose Dose 8 AM 11 AM 8 PM 84

Medication missed doses Store medications in a cool, dry place. Bathrooms, kitchens, and cars are not good places. 85

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Skin Cancer Risk It is essential that you apply sunscreen SPF 30 or greater. 87

Summary Buy supplements indicated on your discharge sheet over the counter at your local pharmacy. Monitor and record blood pressure readings at home. Wear sunscreen SPF 30 or greater while outside. 88

Managing Side Effects A reference for you. 89

Medication Boxes Helps you to organize medications. 90

Types of Medication Boxes Helps you to organize medications. 91

Your medication box should be divided into 7 days and 4 dosing times. Morning Noon Evening Bedtime 92

These columns show you which slot to put your medications in your med box. 93

MORN NOON EVENING BED 95